Colombo Paulina M, Ramadan Ferris A, Kaur Dilsharan, Armenta Darunee, Patterson Peter P, Ellingson Katherine D
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA.
Clinical Translational Sciences, University of Arizona Health Sciences, Tucson, AZ 85721, USA.
Antibiotics (Basel). 2025 Jan 5;14(1):35. doi: 10.3390/antibiotics14010035.
: The COVID-19 pandemic affected antimicrobial stewardship in healthcare, including Skilled Nursing Facilities (SNFs). This study aimed to (1) assess the appropriateness of antibiotic prescriptions for urinary tract infections (UTIs) and respiratory tract infections (RTIs) and identify predictors of inappropriate use; (2) analyze changes in prescribing practices relative to the pandemic's onset. : A retrospective review of electronic medical records from a 300-bed SNF (March 2019-March 2021) identified suspected UTIs and RTIs based on laboratory tests and antibiotic requests. Antibiotic prescription appropriateness was defined by clinical and microbiological alignment with the McGeer criteria, which are standardized infection definitions for long-term care residents, for UTI and RTI. Logistic regression models identified predictors of inappropriate prescribing, and an interrupted time-series analysis (ITS) examined trends relative to the pandemic onset (11 March 2020) in Arizona. : Among 370 antibiotic prescriptions, 77% of UTI and 61% of RTI prescriptions were inappropriate per the McGeer criteria. Acute dysuria and increased urgency were associated with lower odds of inappropriate UTI prescribing. For RTIs, a positive COVID-19 test increased the odds of inappropriate prescribing, while fever and acute functional decline lowered them. UTI prescriptions and inappropriateness overall increased during the pandemic, but no significant ITS trends emerged. For RTIs, no significant changes in prescribing or inappropriateness relative to the pandemic were observed. Findings emphasize the need for robust antimicrobial stewardship during and after public health emergencies.
新冠疫情影响了医疗保健领域的抗菌药物管理，包括专业护理机构（SNFs）。本研究旨在：（1）评估尿路感染（UTIs）和呼吸道感染（RTIs）抗生素处方的合理性，并确定不当使用的预测因素；（2）分析与疫情爆发相关的处方实践变化。
对一家拥有300张床位的SNF在2019年3月至2021年3月期间的电子病历进行回顾性分析，根据实验室检查和抗生素申请确定疑似UTIs和RTIs。抗生素处方的合理性根据与McGeer标准的临床和微生物学一致性来定义，McGeer标准是针对长期护理居民UTI和RTI的标准化感染定义。逻辑回归模型确定了不当处方的预测因素，中断时间序列分析（ITS）研究了亚利桑那州与疫情爆发（2020年3月11日）相关的趋势。
在370份抗生素处方中，根据McGeer标准，77%的UTI处方和61%的RTI处方是不合理的。急性排尿困难和尿急增加与UTI不当处方的几率降低相关。对于RTIs，新冠病毒检测呈阳性会增加不当处方的几率，而发热和急性功能衰退则会降低几率。在疫情期间，UTI处方和总体不合理性增加，但未出现显著的ITS趋势。对于RTIs，未观察到与疫情相关的处方或不合理性的显著变化。研究结果强调在公共卫生紧急情况期间及之后需要强有力的抗菌药物管理。
